Provider Demographics
NPI:1376271288
Name:IBRAHIM, ALI MAHMOUD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:MAHMOUD
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5571 STORMIE KEEP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78266-4435
Mailing Address - Country:US
Mailing Address - Phone:909-919-6611
Mailing Address - Fax:
Practice Address - Street 1:22106 US HIGHWAY 281 N STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7652
Practice Address - Country:US
Practice Address - Phone:210-714-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX388671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice